Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1416 | MN |
NPI | 1003816489 |
---|---|
Provider Name | Dr. G. Thomas Nelson |
First Address | Twin Valley, MN 56584-0310 |
Second Address | Twin Valley, MN 56584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
63573NE | BLUE CROSS\BLUE SHIELD (01) | MN |
T65911 | (02) | MN |